Family Connections versus optimised treatment-as-usual for family members of individuals with borderline personality disorder: non-randomised controlled study

Abstract

BackgroundBorderline personality disorder (BPD) is challenging for family members who are often required to fulfil multiple roles such as those of advocate, caregiver, coach and guardian. To date, two uncontrolled studies by the treatment developers suggest that Family Connections (FC) is an effective programme to support, educate and teach skills to family members of individuals with BPD. However, such studies have been limited by lack of comparison to other treatment approaches. This study aimed to compare the effectiveness of FC with an optimised treatment-as-usual (OTAU) programme for family members of individuals with BPD. A secondary aim was to introduce a long term follow-up to investigate if positive gains from the intervention would be maintained following programme completion.MethodsThis study was a non-randomised controlled study, with assessment of outcomes at baseline (pre-intervention) and end of programme (post-intervention) for both FC and OTAU groups, and at follow-up (3 months post-intervention; 12 or 19 months post-intervention) for the FC group. Eighty family members participated in the FC (n = 51) and the OTAU (n = 29) programmes. Outcome measures included burden, grief, depression and mastery. Linear mixed-effects models were used to assess baseline differences in the outcome measures by gender, age group and type of relationship to the individual with BPD. Linear mixed-effects models were also used to estimate the treatment effect (FC versus OTAU) utilising all available data from baseline and end of programme.ResultsThe FC group showed changes indicating significant improvement with respect to all four outcome measures (p < 0.001). The OTAU group showed changes in the same direction as the intervention group but none of the changes were statistically significant. The intervention effect was statistically significant for total burden (including both subscales; p = .02 for subjective burden and p = .048 for objective burden) and grief (p = 0.013). Improvements were maintained at follow-up for FC participants.ConclusionsThe findings of the current study indicate that FC results in statistically significant improvements on key measures while OTAU does not yield comparable changes. Lack of significant change on all measures for OTAU suggests that a three session psycho-education programme is of limited benefit. Further research is warranted on programme components and long-term supports for family members.

Support, interventions and outcomes for families/carers of people with borderline personality disorder: A systematic review

“…A total of 11 studies describing seven interventions for or involving carers of people with BPD were retained. Six studies were conducted in the USA, two in Australia, one in the Republic of Ireland and two in the UK . Table provides a brief description of each intervention and identifies the associated studies.…”

“…Three of the seven interventions are based on DBT principles, with the others based on cognitive behavioural therapy and transactional analysis, cognitive analytic therapy, mentalization‐based therapy (MBT) and relational models . All interventions were structured as multi‐family group sessions, and none described any additional tailoring to meet individual needs of group members.…”

“…The former study used pretreatment and post‐treatment outcomes plus a 12‐month follow‐up, with the latter using pretreatment, weekly treatment and post‐treatment outcomes plus a 12‐week follow‐up . Another study was a non‐randomized controlled study, comparing Family Connections to ‘optimized treatment as usual' (O‐TAU), using pretreatment and post‐treatment outcomes, plus follow‐up outcomes at 3 months and 12 or 19 months, although there were significant discrepancies in duration of the TAU intervention, which may limit the value of the control group in this study. The remaining eight studies were conducted in naturalistic settings, typically within a community mental health service, with no control group.…”

Improving Family Functioning to (Hopefully) Improve Treatment Efficacy of Borderline Personality Disorder: An Opportunity Not to Dismiss

“…Although these findings are encouraging, it should be observed that the optimized treatment as usual consisted of 3 didactic group sessions of psychoeducation in which information about BPD and the DBT model were provided. Thus, it did not constitute a direct comparison group to the FC intervention due to the significant variation in duration between the programs [47]. Moreover, Cohen d values for treatment effect (FC vs. optimized treatment as usual) ranged from 0.31 (depression) to 0.58 (grief), being in the small-to-moderate range.…”

“…Recently, Flynn et al [47] carried out a nonrandomized controlled study on the effectiveness of FC ( n = 51) as compared to an optimized treatment-as-usual program ( n = 29) in a sample of 80 family members. The FC program showed significantly larger reductions from pre- to postintervention assessments for burden and grief.…”